Using Data to Document the Need for Methamphetamine Services Jane C. Maxwell, Ph.D. Center for Excellence in Drug Epidemiology Gulf Coast Addiction Technology.

Using Data to Document the Need for

Methamphetamine Services

Jane C. Maxwell, Ph.D.Center for Excellence in Drug

EpidemiologyGulf Coast Addiction Technology

Transfer Center

Data Sources• Treatment admission records • Overdose death certificates & Medical

Examiner Reports• Poison Control Center cases • Emergency room data • Price, purity, supply, trafficking data• Surveys (National & State) • Forensic laboratory tests (Police & ME

Labs)• AIDS cases (Health Department)• Community Epidemiology Work Group

(NIDA)

http://www.utexas.edu/research/cswr/gcattc/excellentEpidemiology.html

C o m m u n ity E p id em io lo g y W o rk g ro u p C o rresp o n d en ts

A u stin

N ew O rlean s

A tlan ta

M iam i

S t. L o u is

C h icag oD e tro it

M in n eap o lis

B o sto nN ew Y o rkN ew ark

P h ilad e lp h ia

D .C .

P h o en ix

D en v e r

S ea ttle

L o s A n g e le s

S an D ieg o

S an F ran c isco

H o n o lu lu

http://www.nida.nih.gov/about/organization/CEWG/CEWGHome.html

CEWG Reports

• Divided into sections by drug types: Cocaine/Crack, Heroin, Other Opiates/Narcotics, Methamphetamine, Marijuana, Club Drugs, Alcohol, Benzodiazepines/ Barbiturates, Tobacco

• Discusses each drug type by all available data: Treatment Data, ED Data, Mortality Data, Other Health-Related Data (e.g., Helpline, poison control), Law Enforcement Data (e.g., NFLIS, arrest data), Survey Data, Qualitative Data (e.g., key informant, focus groups)

Texas Overdose Deaths, Treatment Admissions, Poison Control Center Calls

& DPS Lab Exhibits for Methamphetamine & Amphetamine

1

10

100

1000

# Deaths % Tmt Admits % of DPS

Exhibits

PCC Calls

1997 1998 1999 2000 2001 2002 2003

2004 2005

http://www.samhsa.gov

Survey Data

NSDUH State and Substate Reports

• Substate Substance Abuse Estimates from the 1999-2001 NSDUH http://oas.samhsa.gov/substate2k5/toc.cfm

Alcohol, cocaine, marijuana and tobacco by substate regions• State Estimates of Substance Use from the 2003-

2004 National Surveys on Drug Use and Healthhttp://oas.samhsa.gov/2k4State/toc.htm

Past Month Illicit Drug Use, Past Year Marijuana, cocaine, non medical pain reliever Use,  perception of great risk of smoking marijuana, average annual rate of first use of marijuana, past month alcohol use, past month binge alcohol use, perception of great risk of drinking 5 or more drinks once or twice a week, past month tobacco and cigarette use, perception of great risk of smoking one or more packs per day, past year dependence, abuse and treatment for illicit drugs and alcohol, needing but not receiving treatment, serious psychological distress, past month alcohol use and binge drinking by minors

• Methamphetamine Use, Abuse, and Dependence: 2002, 2003, and 2004 http://oas.samhsa.gov/2k5/meth/meth.htm

Shows the states by rates of methamphetamine use.

Methamphetamine Use in Past Month Among Persons Ages 12 or Older, by

Dependence and Abuse: NSDUH 2002, 2003, 2004

433

101

63

357

158

92

237

216

130

0

100

200

300

400

500

600

700

# P

ast

Mon

th U

sers

(in

Tho

usan

ds)

2002 2003 2004

StimulantDependence/Abuse

Other I llicit DrugDependence/Abuse

No I llicit DrugDependence/Abuse

597 607 583

Methamphetamine Use in Past Year Among Persons Ages 12 or Older, by

Gender and Age: NSDUH 2002, 2003, 2004

0.70.5

0.7

1.6

0.4

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

Perc

ent

Male Female Aged

12- 17

Aged

18- 25

Aged

26+

Methamphetamine Use in Past Year Among Persons Ages 12 or Older, by

Race/Ethnicity: NSDUH 2002, 2003, 2004

0 0.5 1 1.5 2 2.5

Native Hawaiian or Other Pacific islander

Two or More Races

American I ndian or Alaska Native

White

Hispanic

Asian

Black

Treatment DataUse TEDS Data and also talk to local

program providers to get information as to their perceptions

of meth treatment need, difficulty in treating, characteristics of clients.

Check with rural programs.

Smoke Inject Inhale Oral All

# Admissions 3,466 2,972 796 343 7,714

% of Stim Admits 46 39 11 5 100

Lag-1st Use to Tmt 8 13 9 10 10

Average Age 28 31 30 31 29

% Male 44 49 43 40 46

% Black 2 0 2 2 1

% White 82 93 82 83 86

% Hispanic 14 5 15 11 10

% CJ Involved 51 53 51 46 52

% Employed 26 17 31 28 23

% Homeless 9 11 7 8 9

Methamphetamines by Route of Administration: Jan-Dec 2005

Characteristics of Clients Admitted to Texas Treatment with a Primary Problem of Amphetamines or

Route of Administration of Methamphetamine/Amphetamin

e:US TEDS Treatment 1992-2003

0

10

20

30

40

50

60

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Smoking Inhalation Injection All Other

Routes of Administration of Methamphetamine of Clients in

Texas Programs: 1988-2005

0

20

40

60

80

100

Smoking

Inhaling

Injecting

Characteristics of Clients Entering Treatment with a Primary Problem with

Methamphetamine/Amphetamine:US TEDS 1993-2003

83

73 2 2

53

73

16

3 2 3

55

0

1020

3040

5060

7080

90

% White % Hispanic % Black % Am

I ndians/AL

Natives

% Asian/Pac

I slanders

% Male

1993 2003

0%

5%

10%

15%

20%

25%

30%

35%

40%

To lose weight To relieve depression

*p< .001

Male

Female

Self-Reported Reasons for Starting Methamphetamine Use

R. Rawson, Methamphetamine: Clinical Challenges and Critical PopulationsR. Rawson, Methamphetamine: Clinical Challenges and Critical Populations

Trends in Methamphetamine/ Amphetamine Admissions to

Treatment: 1993-2003http://oas.samhsa.gov/2k6/methTx/methTX.htm

Admission rates/100,000 for each state: 1993-2003

> 5835 - 58

< 1212 - 35

No data

Primary Amphetamine/MethamphetamineTEDS Admission Rates: 2003

(per 100,000 aged 12 and over)

Residence of Texas Clients Entering Treatment with Problem with

Methamphetamine / Amphetamine:1997-2005*

0%

5%

10%

15%

20%

25%

1997 1998 1999 2000 2001 2002 2003 2004 2005

Urban Rural*DSHS BHIPS Data

Other Treatment Data Sources

• Medicaid data• Hospital discharge data• Local emergency room data

2005 Motor Vehicle Drivers Age 15+ Involved in Accidents with Injuries--Data

from Austin Brackenridge Hospital Trauma Center

Amphetamines 7%

Benzodiazepines 29%

Cocaine 14%

Opiates 31%

THC 46%

None 35%

BAC 0.1%-0.2% 16%

BAC >0.2% 20%

Letter from Dr. Patrick Crocker to Mayor Will Wynn, March 1, 2006.

The National Survey of Substance Abuse Treatment Services

(N-SSATS) is designed to collect data on the location, characteristics, services offered, and number of clients in treatment at alcohol and drug abuse facilities (both public and private) in each state.

Data are available on-line for 2002-2004. Good way to show changes in treatment capacity. Combine with 2003-2004 NSDUH State Estimates.

NFLIS Toxicological Data(Law Enforcement Tox Lab Results)

Google for NFLISDo labs in your state report to NFLIS?

They can easily run the reports by year for you.

If not in NFLIS, check with local law enforcement tox labs and state police

labs for # meth items identified by year

4 Most Frequently Identified Drugs by NFLIS Toxicology Laboratories

0%

10%

20%

30%

40%

Methamphetamine Cannabis Cocaine Heroin

2000 2001 2002 2003 2004 2005

Drugs Identified by NFLIS Laboratories by Region: 2005

0

10

20

30

40

50

Perc

ent

West Midwest Northeast South

Marijuana Cocaine Methamphetamine Heroin

Methamphetamine Identified by NFLIS Laboratories in Selected Metro Areas:

2003-2005

0

10

20

30

40

50

Atlanta Los

Angeles

Portland,

OR

Dallas NYC

2000 2003 2005

Perc

ent

20%

17%

12%

0%

24%

1%

7%

35%

4%

10%

18%

42%

42%

% of Substances Identified by DPS Labs That Were Methamphetamine & Amphetamine: 2001

30%

30%

18%

0.5%

26%

1%

11%

38%

4%

16%

28%

41%

55%

% of Substances Identified by DPS Labs That Were Methamphetamine: 2005

2001 2005

Hidalgo (McAllen) 0% 1%Webb (Laredo) 1% 2%El Paso (El Paso) 4% 4%Nueces (Corpus Christi) 9% 16%Harris (Houston) 6% 12%Travis (Austin) 17% 28%McLennan (Waco) 19% 32%Smith (Tyler) 16% 34%Dallas (Dallas) 32% 38%Midland (Odessa) 12% 25%Taylor (Abilene) 41% 55%Lubbock (Lubbock) 23% 28%Potter (Amarillo) 41% 43%

Percent of Items Analyzed by Texas DPS Laboratories as Methamphetamine, by County and City: 2001 and 2005

Drug Abuse Warning Network: Emergency

Departments

Characteristics of DAWN ED Stimulant Patients: 2003-2006

0

10

20

30

40

50

60

70

% Male % White % Black % Hispanic

*The unweighted data are from all U.S. EDs reporting to DAWN. All DAWN cases are reviewed for quality control. Based on this review, cases may be corrected or deleted, and, therefore, are subject to change. SOURCE: DAWN, OAS, SAMHSA, downloaded 2/26/2006)

Ages of DAWN ED Stimulant Patients: 2003-2006

0

5

10

15

20

25

<21 21- 24 25- 29 30- 34 35- 44 45- 54 55- 64

*The unweighted data are from all U.S. EDs reporting to DAWN. All DAWN cases are reviewed for quality control. Based on this review, cases may be corrected or deleted, and, therefore, are subject to change. SOURCE: DAWN, OAS, SAMHSA, downloaded 2/26/2006)

Route of Administration of Stimulants of DAWN ED Patients: 2003-2006

20%

31%

13%

36%

1%

*The unweighted data are from all U.S. EDs reporting to DAWN. All DAWN cases are reviewed for quality control. Based on this review, cases may be corrected or deleted, and, therefore, are subject to change. SOURCE: DAWN, OAS, SAMHSA, downloaded 2/26/2006)

Specific Type of Case Reported by DAWN ED Stimulant Patients: 2003-

2006

70%

4%

Overmedication, 4%

Accidental I ngestion,

1%

Adverse Reaction,

1%

Suicide Attempt,

19%

*The unweighted data are from all U.S. EDs reporting to DAWN. All DAWN cases are reviewed for quality control. Based on this review, cases may be corrected or deleted, and, therefore, are subject to change. SOURCE: DAWN, OAS, SAMHSA, downloaded 2/26/2006)

Disposition of Stimulant Patients Seen in DAWN ED: 2003-2006

Discharged Home

Police/Jail

Referred to CD Tmt

Admitted to CD Tmt

Admitted to ICU

Admitted to Psy Unit

Admitted to Other Inpatient

Transferred

Left AMA

Other

*The unweighted data are from all U.S. EDs reporting to DAWN. All DAWN cases are reviewed for quality control. Based on this review, cases may be corrected or deleted, and, therefore, are subject to change. SOURCE: DAWN, OAS, SAMHSA, downloaded 2/26/2006)

Drug Abuse Warning Network: Medical

Examiners

Check DAWN Medical Examiner Death Data from 122 Areas and 6

States on SAMHSA’s web site under Statistics and

Data

Stimulant Deaths Reported for Selected Metro Areas in DAWN: 2003

0 20 40 60 80 100 120 140

AlbuquerqueAtlanta

BaltimoreBirmingham

BostonBuff aloChicago

ClevelandDenverDetroit

HoustonI ndianapolisKansas City

LouisvilleMiami

MilwaukeeMinneapolis

New OrleansNew York

OgdenOklahoma City

PhiladelphiaPhoenix

Portland ORPortland ME

ProvoSalt Lake City

San DiegoSan Francisco

SeattleSt Louis

Washington DCMaine

MarylandNew Hampshire

New MexicoUtah

Vermont

Local Medical Examiners

• Number of deaths with “amphetamine” or “methamphetamine” mentioned on the death certificate.

• Trend by year• Trend by race/ethnic and gender• Most death certificates won’t say

which drug “caused” the death but will indicate drugs found in the body.

Poison Control Center Data

Poison Control Centers• Poison Control Centers receive data on confirmed human

exposure cases, animal poison exposures, human and animal non-exposures, and informational calls.

• For tracking patterns of drug use, request confirmed human exposures, as well as the age, age group, and gender, along with the county the call came from and the date. Also request the fields describing the substance used, including the field with the slang term name.

• Ask for Intentional. An intentional misuse is one resulting from the intentional improper or incorrect use of a substance for reasons other than the pursuit of a psychotropic or euphoric effect. Intentional abuse is an exposure resulting from the intentional or incorrect use of a substance where the victim was likely to be attempting to achieve an euphoric or psychotropic effect. All recreational use of substances for any effect are included in this category.

Worrisome Trends in Texas. Similar in Other

States?

Methamphetamine Lab Seizure and Purity Data: Dallas DEA

Field Division

0%

10%

20%

30%

40%

50%

60%

70%

80%

1Q 2005 1Q 2005 3Q 2005 4Q 2005 1Q 2006 2Q 2006

0

10

20

30

40

50

60

70

80

90

100

Average purity

Labs Seized (byquarter)

Changes in Price of a Pound of Ice in Houston from 1st Half 2004 to 2nd Half of

2005

$17,000

$15,000

$13,000

$8,000

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

$18,000

1st H 2004 2nd H 2005

Effects of Methamphetamine on Others

• Need protocols to involve CPS, law enforcement, health, etc.

• Drug Endangered Children’s Units—but don’t forget Adult Protective Services—they may be cooking at granny’s house.

• EMS—managing agitated and aggressive patients

• ER—meth patients have intentional self-injury or assaults—older, longer hospital stays, cost more. Violent, need to be detoxed.

• With burns victims, need drug screens to ID meth use to manage

• Secondary contamination to ED personnel.• Police, fire, social workers need certification in

hazardous materials (HAZMAT) handling. $5000 to clean up a lab.

• Increase in hepatitis with injecting drug use.• Change when Ice moves in?

Effects on Communities

• EMS—managing agitated and aggressive patients

• ER—meth patients have intentional self-injury or assaults—older, longer hospital stays, cost more. Violent, need to be detoxed.

• With burns victims, need drug screens to ID meth use to manage

• Secondary contamination to ED personnel.• Police, fire, social workers need certification in

hazardous materials (HAZMAT) handling. $5000 to clean up a lab.

• Increase in hepatitis with injecting drug use.• Change when Ice moves in?

Other Data Sources• HIV/STD outreach and testing

programs (% having used meth, race/ethnic, gender, reasons for use)

• Narcotics officers (what’s on the street, price, purity, source, new users, different forms of meth)

• Bartenders and bouncers in clubs.• CPS workers.• EMS workers.

Areas to Watch

• Use of meth on the job (Work Force needs)• Truckers, day laborers, people working

long hours and boring jobs.

• Risky sexual behaviors• Heterosexuals & homosexuals.• Party people • Immigrants/migrants away from home

and families.

• Increasing criminal distribution• Traffickers following the migrant trail.• More organized and criminal gangs.

1998 Miami DMP SamplesSouthwest Asian 2.1 % Pure

Southeast Asian 2.3 % Pure

South American 19.2 % Pure

HeroiHeroinn

Heroin Sources and Supply Routes

Sources of Heroin Seized in US Based on Net Weight:1989-2003

0

20

40

60

80

100

1989

1991

1993

1995

1997

1999

2001

2003

SEAsian

SWAsian

Mexican

So. American

DEA Heroin Signature Program

Average Purity of Heroin Samples in the US:

1992-2003

0%

20%

40%

60%

80%

100%

Southeast

Asian

Southwest

Asian

Mexican South

American

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003DEA Heroin Signature Program

50%31%

11%

10%

51%

48%

34%

16%

14%

24% 16%

41%

14%

39% 28%

43%

28%

52%16%

WestAverage Purity: 26%Mexican

EastAverage Purity: 42%So. American

Heroin Purity: 2004

25%

53%

Age & Ethnicity of Texas Deaths with a Mention of

Heroin:1990-2004

0

100

200

300

400

500

35

36

37

38

39

40

Avera

ge A

ge

White Hispanic Black Age

OTHER OPIATES•Hydrocodone (such as Vicoden) is larger problem than oxycodone or methadone in Texas •Problem with methadone pain pills (as compared to diskettes and syrup used in narcotic treatment programs).•Diversion and abuse of OxyContin has created new demand for narcotic treatment in many states.•Watch for diversion of buprenorphine.

Google ARCOS to get amount of prescription controlled substances shipped from

manufacturer to final dispensing site by state and

by zip code

Quantities of Hydrocodone and Oxycodone Distributed to Retail Registrants: ARCOS 1997-2004

0

5000000

10000000

15000000

20000000

25000000

30000000

1997 1999 2001 2003

Hydrocodone

Oxycodone

24 or more

6-9

<6

Incomplete data 12-15

Other Opiate Treatment Admissions per 100,000 by State, TEDS: 1993

KEY YEAR: 1993

10-11 16+

24 or more

6-9

<6

Incomplete data 12-15

Other Opiate Treatment Admissions per 100,000 by State, TEDS: 1997

KEY YEAR: 1993

10-11 16+

16 or more< 6

6-9Incomplete data 12-15

Other Opiate Treatment Admissions per 100,000 by State, TEDS: 2003

KEY YEAR: 1992

10-11

“SYRUP” in Texas Codeine cough syrup continues to be

abused. Sold in baby bottles, measured in

ounces. Pint sells for $200-$300. Cut with Karo syrup and put in 3 liter

soft drink bottle to drink.•Pineapple Soda Water and “Lean” Rap music on syrup continues.

COCAINEStill Around—

with New Users

Characteristics of Texas Clients Admitted to DSHS-Funded Treatment with a Primary Problem of Cocaine: 2005

Crack Powder Cocaine Powder Smoke Inject Inhale

% of Cocaine Admits 64% 6% 307%Lag-1st Use to Tmt- 12 16 9Average Age 37 35 29 % Male 51% 60% 48%% Employed 14% 14% 34%% Homeless 16% 12% 4%

Race-Ethnicity of Texas Cocaine Admissions: 1993 v.

2005

0%

20%

40%

60%

80%

100%

Crack-

93

Crack-

05

IDU-

93

IDU-

05

Inhale-

93

Inhale-

05

Black White Hispanic

Age & Ethnicity of Texas Cocaine Overdose Deaths:

1992-2004

0100200300400500600700800

30

32

34

36

38

40

42

Ave

rage

Age Black

Hispanic

White

Av. Age

% Texas Secondary Students Who Had Ever Used Powdered Cocaine and Crack, by Grade:

2004

0%

5%

10%

15%

20%

25%

Grade

7

Grade

8

Grade

9

Grade

10

Grade

11

Grade

12

Cocaine- Border

Cocaine- Non-Border

DOWNERS

• Barbiturates (phenobarbital), benzos (diazepam-Valium, alprazolam-Xanax, clonazepam-Klonopin, lorazepam-Ativan, chlordiazepoxide-Librium).

• Potentiate low-quality heroin (and seen in heroin overdoses)

• Come down from speed or cocaine trips

• Dependence among females

Benzodiazepines Identified by Texas DPS Labs:

1998-2005

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

Xanax Valium Klonopin

1998

1999

2000

2001

2002

2003

2004

2005

MarijuaMarijuananaMarijuaMarijuanana

Reefer Sadness

Reefer Sadness

% Texas Secondary Students Who Had Used Any Illicit Drug in the Past Month, by Ethnicity: 1988-

2004

0%

5%

10%

15%

20%

25%

Anglos

African Americans

Hispanics

Addiction Severity Index Problems of Texans Treated with Primary

Marijuana Problem: 2005

0% 20% 40% 60% 80%

Sickness

Employment

Family

Social

Emotional

Sub. Abuse

Non- CJ Referral

CJ Referral

Secondary Problem Drug for Clients Entering Treatment with a Primary

Problem with Cannabis: 2005

43

28

1

12

39

28

5

12

0

10

20

30

40

50

No Drug Alcohol Crack Powder Coke

CJ Referral Non- CJ Referral

# Days Used Drugs in Month Prior to Admission: 2005

6

32

10

54

0

2

4

6

8

10

12

Used Marijuana Used Drug 2 Used Drug 3

CJ Referral Non- CJ Referral

Alcohol

Characteristics of Alcohol Clients at Admission to Texas

Programs: 1988 v 2005

82

63

7

28

10

35

6657

12

29

11

37

0

20

40

60

80

100

% Male % White % Black %

Hispanic

%

Homeless

Av. Age

1988 2005

2nd Drug of Abuse of Texas Alcohol Clients: 1988 v.

2005

2005 Admissions

None51%

Cocaine12%

Marijuana12%

Other21%

Stimulants4%

1988 Admissions

None67%

Marijuana18%

Other4%

Stimulants4%

Cocaine7%

Club Drugs• Problems identified early: MDMA in 1985,

GHB in 1990,Ketamine in 1991, Rohypnol in 1993, but slow responses.

• Research studies underway but are incomplete and can be problematic.

• Use of Internet to obtain information from pro & anti-drug sites (BUT information can be erroneous, untested, outdated, or extreme).

• Problems testing & identifying various drugs.

• Lack of detox & treatment protocols.

• Misperception that all club drugs are alike.

Substances Identified by Labs Participating in the National

Forensic Laboratory Identification System: 1997-

2005

0%

20%

40%

60%

80%

100%

MDMA

Heroin

Methamphetamine

Cocaine

Cannabis

Club Drugs in Texas Club drugs can be a ticket to

treatment—often with poor outcomes. Ecstasy treatment numbers are up and

it is moving out of the club scene. GHB centered in DFW metroplex. Rohypnol—blue punch to get around

dye. Ketamine numbers low. PCP indicators rising—”Buck Naked”. Coricidin HPB (“Skittles”) used by kids

. Lack of evidence-based treatment for

the dependent.

Admissions to Texas Treatment Programs by Primary, Secondary or Tertiary Problem with a Club

Drug: 1988-2005

0

100

200

300

400

500

600

700

800

900

1988

1990

1992

1994

1996

1998

2000

2002

2004

Ecstasy

GHB

Hallucinogens

Ketamine

Rohypnol

PCP

% of All Drugs Identified by Texas DPS Labs: 1998-2005

0.0%

0.2%

0.4%

0.6%

0.8%

1.0%

1.2%

1.4%

1.6%

1.8%

LSD Ecstasy PCP Ketamine GHB, GBL,

1- 4BD

Rohypnol

1998 1999 2000 2001 2002 2003 2004 1/2 2005

Admissions to DSHS-Funded Treatment Programs With a 1st, 2nd, or 3rd Problem

With a Club Drug: 2005

0%

20%

40%

60%

80%

100%

Ecstasy GHB Halluc PCP Rohypnol

0

5

10

15

20

25

30

35

Ave

rage

Age

White Black Hispanic Age

Primary Problem of Club Drug Admissions to Texas Programs:

2005

0%10%20%30%40%50%60%70%80%90%

100% Other Opiates

Rohypnol

PCP

Ketamine

Halluc

Heroin

GHB

Ecstasy

Amp/ Meth

Crack

Powder Coke

Alcohol

Marijuana

Ecstasy• “Ecstasy” can be MDMA, MDA, MDE, PMA, etc.• MDMA can result in dependence or abuse but

evidence-based treatment protocols do not presently exist.

• MDMA can damage serotonin neurons.• MDMA use can result in depression, sleep, mood &

anxiety disturbances, & memory deficits.• Heavy users displayed deficits on many measures of

neuropsychological tests, particularly those associated with mental processing speed & impulsivity.

• Selective impairments of neuropsychological performance associated with regular use not reversed by prolonged abstinence.

• Higher scores on SCL-90 for phobic anxiety, obsessive-compulsive behavior, psychosis, somatization & loss of sex and pleasure.

• Research on effects of ecstasy continuing to emerge.

Race/Ethnicity of Texas Clients Admitted with a Problem with

Ecstasy: 1990-2005

0%10%20%30%40%50%60%70%80%90%

100%

1990

1992

1994

1996

1998

2000

2002

2004

White

Hispanic

Black

Ecstasy Indicators in Texas

1

10

100

1000

PCC Calls Treatment DPS Labs Deaths

1998 1999 2000 2001 2002 2003 2004 2005

NDARC Study of Ecstasy Users*

•N=329; young, well educated, employed or students; oversample of heavy users.•Polydrug users with high IDU rates.•Young female polydrug users & those who binged on ecstasy for 48 hours reported physical, psychological, & other problems which they attributed to ecstasy use.•Users may benefit from credible information to modify use and reduce problems.•Need treatment options to meet demand indicated.•Topp, Hando, Dillon et al., Ecstasy Use in Australia, Drug and Alcohol Dependence 55 (1999) 105-115.

GHB, GBL, 1-4 BD,Fantasy

GHB• Use associated with little

precision in doses, with effects varying from euphoria to somnolence to coma.

• GHB and alcohol together reported to be synergistic.

• Withdrawal is complicated and requires detoxification in a medical setting.

• Abuse potential is known but little information on treatment.

GHB Adverse Effects• Central Nervous System depressant--

intoxication, then deep sedation.• GBL and 1-4BD turn into GHB when

swallowed. • Role of web re: inaccurate information

and availability.• Threat of drink spiking.• Tolerance & dependence build rapidly.• Intervention & treatment may be

delayed because providers lack knowledge about GHB dependence. Little information on treatment.

NDARC Study of GHB Users*

• N=76; recent users of GHB• Used GHB in combination with

other drugs: 30% drank 5+ drinks, 20% used Ketamine.

• 4% dependent on GHB.• Frequent reports of adverse

effects.• Half had overdosed on GHB• GHB used with other drugs may

place users at significant risk of range of negative consequences.*Degenhardt, Darke, Dillon, “GHB use among Australians,” Drug & Alcohol Dependence

67 (2002), 89-94

LSD

• Slang terms--Acid, Blotter, or name of picture on tab.

• Is a small paper square with picture or jello-like square tab.

• Desired Effects--distortion of senses, introspection.

• Adverse Effects--anxiety, panic reaction, or “Bad Trip.”

• LSA?—extracted from morning glory or wood rose seeds—less potent?

• More prevalent than we think?

SPECIAL ANNOUNCEMENTS FROM MARK/JLF (updated 12-11-01)

SHOP OUR CATALOG

DISCLAIMER AND INFORMATION

"JLF sells poisonous-non-consumable items, consisting of various raw materials and related merchandise used for art, hobby, science, industry, and/or religion. Products include Amanita muscaria ("Fly Agaric") mushrooms, Claviceps purpurea ("Ergot Fungus") sclerotia , Trichocereus pachanoi ("San Pedro") cactus, Psilocybin mushroom spores and kits, Papaver somniferum ("Opium Poppy") pods, Argyreia nervosa ("Hawaiian Baby Woodrose") seeds, Anadenanthera colubrina ("Cohoba") seeds, and many other ethnobotanicals. Also pure compounds such as yohimbine, L-tryptophan, etc."  

JLF Poisonous Non-ConsumablesP.O. Box 184Elizabethtown, IN 47232

DISSOCIATIVE DRUGS: PCP, Ketamine, DXM

Distort perceptions of sight and sound and produce feelings of

detachment, but not hallucinations (Zombie

effect)

Phencyclidine

• PCP, Angel Dust, Killer Weed• Dissolved in embalming fluid

(“Fry,” “Amp,” “Water, Water”).• Swallowed, sniffed, smoked on

joints dipped in “Fry”.• NYC—menthol cigarettes are

dipped into liquid PCP or blunts are laced with powdered PCP.

• Washington, DC—”dippers”—cigarettes dipped into PCP.

PCP Indicators in Texas

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PCC Calls Treatment DPS Labs Deaths

1998 1999 2000 2001 2002 2003 2004 2005

KETAMINE

• Anesthesia doses 2-10 mg/km; recreational doses 50-100 mg.

• Unsafe sexual behavior associated with frequent use of Ketamine. Use at gay circuit parties of concern.

• Taken in cyclical binges similar to cocaine or methamphetamine.

• Available as powder to snort or as liquid to inject; used with “puffers” to get exact dosing.

• Users can become psychologically dependent but no evidence of physiologic withdrawal syndrome.

SPECIAL K (Ketamine)

NDARC Study of Ketamine Users*

• N=100; well-educated; older group of party drug users.

• Some had access because in medical field.

• Used with MDMA, MDA & amphetamines.• Many had regular negative side effects

such as inability to speak, blurred vision, lack of coordination.

• Issue for warnings: Usually unpleasant side effects seen by some as “positive” and encouraged experimentation.

*Dillon, Copeland, Jansen, Patterns of Use and Harms Associated with Non-Medical Ketamine Use, Drug and Alcohol Dependence 69 2003) 23-28.

What isWhat is DxM DxM? ? DextromethorphanDextromethorphan is a is a psychoactive drug found in common over the counter psychoactive drug found in common over the counter cough medicines.cough medicines.

Source: www.http:third-plateau.lycaeum.org/beginner/index.html

• ““Robotrip” – high dosages can produce Robotrip” – high dosages can produce hallucinogenic effects hallucinogenic effects

• Part of family of psychoactive compounds Part of family of psychoactive compounds called “dissociative anesthetics.”called “dissociative anesthetics.”

• Some effects have been described as Some effects have been described as similar to those of ketamine (Special K) similar to those of ketamine (Special K) and PCP.and PCP.

• The DxM experience is described as occurring on levels, or plateaus depending on the amount of the dose taken.

• Each plateau is different from another. There are 4 major plateaus + a fifth one that is generally unpleasant and involves a possible trip to the hospital

Source: www.http:third-plateau.lycaeum.org/beginner/index.html

DXM Calculator

HIV Cases in Texas: 1987-2005

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Texas HIV Cases by Gender & Race/Ethnicity: 1987-2005

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www.gcattc.net

www.samhsa.gov